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2. *Obstetricalemergenciesareacutesudden
complicationsthatcanoccurduringpregnancy,
labor,orthepostpartumperiod.
*Thesesituationsareoftenlifethreateningfor
bothmotherandthebaby.Requiringimmediate
identificationandintervention.Understanding
theseemergenciesiscrucialforhealthcare
professionalstoprovidepromptandeffective
care.
INTRODUCTION

3. Common obstetrical
emergencies
1.Postpartum hemorrhage
2.Eclampsia
3.Uterine rupture
4.Shoulder dystocia
5.Cord prolapse
6.Amniotic fluid embolism
7.Placental abruption
8.Placenta previa

4. 1.POSTPARTUM
HEMORRHAGE (PPH)
Postpartumhemorrhageorpphistheoneoftheleadingcauses
ofmaternalmortality.Itisdefinedasthebloodlossexceeding
500mlaftervaginaldeliveryormorethan1000mlaftercesarean
section.
MAIN CAUSES: 4Ts –Tone , Trauma , Tissue , Thrombin
MANAGEMENT : Immediate uterine massage
administration of uterotonicdrugs
(oxytocin and misoprostol) IV fluid replacement
surgical intervention if bleeding cannot be controlled.

5. 2. ECLAMPSIA
Eclampsiaistheseverecomplicationpreeclampsia.
Characterizedbyseizuresinapregnantwoman
withhighbloodpressureandproteinintheurine.
SIGNS:

6. 3. SHOULDER DYSTOCIA
DEFINITION
Difficultyencounteredinthedeliveryofthefetal
shouldersafterdeliveryofthehead.
Itisthecomplicationofvaginaldeliverythatrequries
additionalobstetricalmanoeuvertoreleasethe
shouldersofthebaby.
Duetoimpactionofthefetalshoulderbehindthe
symphysispubis

7. RISK FACTORS
ANTEPARTUM FACTORS
INTRAPARTUM
FACTORS
❑Maternal obesity
❑Maternal diabetes
mellitus
❑Post term
pregnancy
❑Excessive weight
gain
❑Prolonged second
stage of labor
❑Oxytocin induction
❑Vacuum extraction

8. DIAGONSTIC
EVALUATION
➢Fail spontaneous restitution
➢Fail to deliver the shoulder
➢Turtle sign
➢Prolonged second stage

9. MANAGEMENT
H call for HELP
E Evaluate for EPISIOTOMY
LLegs : MC robertsmanoeuver
P Pressure externally suprapubic
EEnter : rotational manoeuver
R Remove the posterior arm
RRoll the patient

10. MC ROBERTS MANOEUVER
It’s performed by
pressing pregnant
person’s legs against
abdomen.
After knee fluxion
towards the abdomen of
the mother

11. COMPLICATON :
MATERNAL FETAL
➢Atonic uterus
➢Exhaust
mother
➢PPH
➢Infection
➢Prolonged
labor
➢Ruptured
uterus
➢Brachial plexus
➢Nerve injury
➢Humerusfracture
➢Death

12. 3. UTERINERUPTURE
Uterine rupture is a rare but serious obstetrical complication.
It involves a full thickness tear of the uterine wall.
It can occur during late pregnancy or labor.

13. INCIDENCE AND RISK FACTORS
INCIDENCE:
•0.5-1% in women with a previous cesarean section.
•Rare in unscarred uterus.
RISK FACTORS:
•Previous uterine surgery (especially classical C-
section).
•Trial of laborafter cesarean(TOLAC)
•Uterine overdistension(e.g. multiple
pregneancy)
•Obstructed labor
•Trauma
•Misuse of oxytocin

14. TYPES OF UTERINE RUPTURE :
•COMPLETE RUPTURE :alllayersof
uterus(endometrium,myometrium,
perimetrium)aredisrupted.
•INCOMPLETE RUPTURE
(DEHISCENE) : Uterine muscle tears, but
peritoneum remains intact.

16. Diagnosis and clinical
presentation
DIAGNOSIS :
•Clinical suspicious during labor
•Fetal heart rate monitoring
•Utlrasound
•Confirmed during laparotomy
CLINICAL PRESENTATION :
•Sudden, severe abdominal pain
•Cessation of uterine contraction
•Vaginal bleeding
•Abnormal fetal heart rate
•Signs of maternal shock: tachycardia, hypotension

17. *Hemorrhagic shock
*Uterine atony
*Sepsis
*Death
*Hypoxia
*Stillbirth
*Neonatal brain
injury
COMPLICATIONS

19. 4. CORD PROLAPSE
•Cord prolapse is an obstetric emergency where the
umbilical cord slips below the presenting part of the
fetus.
•It can cause fetal hypoxia due to cord compression
or spasm.
•Requires immediate intervention to save the fetus.

20. TYPES OF CORD PROLAPSE :
1.OVERT (Visible) prolapse:
Cord slips out of the cervix and is visible
or palpable in the vagina.
2. OCCULT (hidden) prolapse :
Cord lies alongside the presenting part but is
not externally visible.

21. RISK FACTORS
•Malpresentation(breech. Transverse lie)
•Prematurity and low birth weight
•Multiple pregnancies
•Long umbilical cord
•Grand multiparity
•Artificial rupture of membranes

23. CLINICAL PRESENTATION
*Sudden fetal
bradycardiavariable
decelerations on CTG
*Visible or palpable cord
in the vagina or outside
vulva
*May or may not be
associated with bleeding
or contraction
DIAGNOSIS
*Clinical examination :
Cord felt or seen
protruding through
vagina
*Fetal monitoring :
Sudden bradycardiaor
decelerations
*Ultrasound : May detect
occult prolapse
CLINICAL PRESENTATION AND
DIAGNOSIS

24. EMERGENCY MANAGEMENT
•Call for help (obstetric team, anesthetist,
pediatrician)
•Place mother in knee-chest or trendelenburg
position
•Manually elevate presenting part off the cord
•Avoid handling cord (to prevent vasospasm)
•Administer oxygen to mother
•Monitor fetal heart continuously)
•Emergency cesarean section is the treatment of
chioce

25. COMPLICATION
FETAL :
•Hypoxia
•Stillbirth
•Cerebral palsy due to prolonged compression
MATERNAL :
•Psychological trauma
•Complication from emergency cesarean

26. 5. AMNIOTIC FLUID EMBOLISM (AFE)
Amniotic fluid embolism is a rare, sudden, and life-
threatening obstetric emergency.
It occurs when amniotic fluid, fetal cells, or other
debris enter the maternal circulation, triggering a
severe immune-like reaction.

28. INCIDENCE AND
MORTALITY
•Incidence : ~1 in 20000 to 1 in 50000
births
•Maternal mortality 20-60%
•High risk of permanent neurological damage
or death in both mother and fetus

29. ETIOLOGY/ CAUSES
Exact cause unknown but often associated with:
•Labor and delivery
•Cesarean section or instrumental delivery
•Uterine trauma or rupture
•Placenta previaor abruption
•Induction of labor

30. PATHOPHYSIOLOGY
1.Amniotic fluid enters maternal circulation.
2.Triggers a massive inflammatory
andanaphylactoidreaction
3.Leads to :
pulmonary vasoconstriction –right heart
failure
left heart failure
disseminated intravascular coagulation
multi-organ failure

32. CLINICAL PRESENTATION
1.RESPIRATORY PHASE:
• sudden shortness of breath (dyspnea)
• hypoxia and cyanosis
• pulmonary edema
• seizures or altered consciousness
2. CARDIOVASCULAR COLLAPSE:
• hypotension
• cardiac arrest
• shock
3.HEMORRHAGIC PHASE:
• Massive bleeding
• uterine atony
• coagulopathy (low platelets, abnormal clotting)

33. DIAGNOSIS
oClinical diagnosis : no specific test
oSuspect in any mother with sudden
cardiorespiratory collapse and DIC.
oSupportive investigation:
•ABG (hypoxemia)
•coagulation profile
•chest X-ray

34. MANAGEMENT
Emergency , supportive care is critical :
airway and breathing : oxygen administration
intubation and mechanical
ventilation if needed
circulation : IV fluids , vasopressor
cardiac monitoring
CPR if required
coagulation support : blood and plasma transfusion
platelets
manage DIC aggressively
delivery : if undelivered fetus emergency cesarean to
improve maternal resuscitation

35. COMPLICATION
•MATERNAL :
Cardiopulmonary failure
DIC and hemorrhage
renal or hepatic failure
death
•FETAL :
hypoxia
stillbirth or neonatal death
neurological damage

36. 6. PLACENTAL ABRUPTION
“Placental abruption is when the placental detaches
from the uterine wall before the baby is born . This
causes bleeding and can cut off oxygen supply to the
fetus.
The condition is often very painful and may cause a
tender uterus and fetal distress. Treatment depends
on the severity, but in emergencies, the baby may
need to be delivered immediately”

38. 7. PLACENTAL PREVIA
Placentalpreviaiswhentheplacentacoversthe
cervixpartiallyorcompletely.Itusuallypresentsas
painless,brightredbleedinginthethirdtrimester.
Amajorriskishemorrhagicduringlabor.
Diagnosisisconfirmedwithultrasound,and
managementinvolvesavoidingvaginalexamsand
planningacesareandeliveryespeciallyiftheprevia
iscomplete.

40. ROLE OF NURSE
Nurseplayavitalroleinmanagingobstetrical
emergencies.
Theirresponsibilityinclude:
recognitionofdangersigns,
continuousmonitoringmotherandfetus,
administeringmedications,preparingfor
emergencyproceduresandsupportivewoman
emotionally.Quickactionandgood
communicationwiththehealthcareteamare
essentialinsavinglives.